Coccydynia (Tailbone Pain) Treatment Brisbane

Written by Dr Joshua Hatch, Musculoskeletal GP, RACGP Fellow, Diploma in Musculoskeletal Medicine (FSEM UK).

Coccydynia is pain at the tailbone, the small bone at the very bottom of the spine. It is usually worst when sitting, especially leaning back, and at the moment of standing up.

The coccyx is a small chain of three to five fused or partly fused vertebrae at the base of the spine. It forms one leg of the tripod you sit on, together with the two sitting bones, and it takes more of the load when you lean back. A backward fall, childbirth, long hours on hard seats and a coccyx that moves abnormally when you sit are the common causes. It is several times more common in women.

Assessment focuses on confirming the tailbone as the source, since pain can also come from the lower back, the sacroiliac joints, the pelvic floor muscles or a pilonidal sinus, and on screening for the uncommon serious causes such as infection or a tumour. Fever, weight loss, night pain, bowel bleeding or any change in bladder or bowel control needs prompt review. Imaging is used selectively, and seated and standing x-rays are the most informative when it is.

First-line care is a wedge or cut-out cushion that takes pressure off the tailbone, regular breaks from sitting, sitting upright rather than slouched back, simple pain relief, avoiding constipation, and pelvic floor physiotherapy. For pain that persists, options with small trials behind them include shockwave therapy and an injection around the sacrococcygeal joint, and a specialist ganglion impar block is used for more stubborn pain. Surgical removal of the tailbone is reserved for the few people whose pain does not respond to a thorough trial of non-surgical care.

Common symptoms

Pain in the midline at the very bottom of the spine
Worse sitting, particularly on hard seats or leaning back
A sharp jolt of pain when rising from sitting
Sometimes pain with cycling, opening the bowels or intercourse

Every treatment reviewed for this diagnosis

Evidence for twelve treatment options in coccydynia (tailbone pain)

This is not a fixed ladder or a package of treatments. Every option is assessed independently against this diagnosis, including treatments with limited direct research that may still be reasonable for a clearly defined tissue target. The evidence level, likely benefit, risks, cost and alternatives are weighed at consultation.

Foundation — diagnosis, education and rehabilitation

The part of care with the broadest relevance. For many people it is enough on its own; other options are judged against it, not automatically added after it.

Diagnosis, education and progressive rehabilitation Working out what is driving the pain, explaining what your imaging does and does not mean, and building a graded loading plan you can actually follow. Core care

What it involves

Assessment to identify the likely pain source, an explanation of what the diagnosis means, adjustment of the loads that aggravate it, and a progressive strength and conditioning plan — with weight management where that is clinically relevant.

What the evidence shows

Conservative care is first line in every review: cushions that offload the coccyx, sitting posture, anti-inflammatories, pelvic floor physiotherapy and manual therapy (Foye, StatPearls 2025; Mazzoleni, Ann Joint 2025). Small randomised trials support stretching, kinesiotaping with exercise, and intrarectal manipulation (mild effect), and in a retrospective series of 79 people completing pelvic floor physiotherapy average pain fell from about 5 to 2 out of 10 (Scott, PM R 2017). Conservative care is often quoted as successful in about 90 per cent, but in a prospective cohort of 115 adults with chronic coccydynia symptoms persisted at 36 months in more than half (Charriere, Eur Spine J 2021).

Pairing reviewed 2026-09-28.

Where it fits for you

Where I start: a cut-out or wedge cushion, sitting and break habits, simple analgesia, avoiding straining, and referral for pelvic floor physiotherapy. Screening for infection, tumour and referred pelvic causes happens at the same visit.

Muscle and symptom-modifying options

Useful only when the examination identifies the tissue they target or when short-term pain control creates a useful rehabilitation window.

Wet needling and trigger point injection (trigger point injection) A fine needle into a tender band of muscle, with a small volume of dilute glucose solution injected through it. Only if relevant

What it involves

The needle is placed into the tender muscle band and a small volume of 5% glucose with 0.02-0.08% lignocaine is injected. Often done in the same visit as your assessment, and usable where the tender area sits deeper. Dry needling — the same technique with nothing injected — is not offered here.

What the evidence shows

No controlled trial of needling in coccydynia was identified. Coccygeus trigger point injections were used as a secondary treatment in 17 per cent of a retrospective pelvic floor physiotherapy cohort, without separate outcomes (Scott, PM R 2017), and dry needling of gluteus maximus trigger points has been proposed in correspondence only (Temel, Med Acupunct 2023).

Pairing reviewed 2026-09-28.

Where it fits for you

Only where a tender band in gluteus maximus or the muscles around the coccyx is reproducing part of the pain. It is not treatment of the coccyx itself.

Ultrasound-guided injections Guidance means we can see the needle reach the target. What goes into the needle depends on the diagnosis. Small trials

What it involves

The injection is performed under ultrasound so the needle can be watched into the target structure. What is injected is decided by the diagnosis — and corticosteroid is used sparingly, for the reasons set out below.

What the evidence shows

Corticosteroid injection around the sacrococcygeal joint is widely used and appears most helpful when pain is under about six months old (Foye, StatPearls 2025). The trial evidence is small: ultrasound guidance was no better than a landmark-guided injection in 30 patients, and in a 34-patient trial shockwave gave more durable relief than steroid over six months (both Ahadi 2022, in Mazzoleni, Ann Joint 2025). A narrative review concluded no high-quality study yet supports any injection-based treatment (White, PM R 2021).

Pairing reviewed 2026-09-28.

Where it fits for you

Considered for pain that persists despite cushioning and physiotherapy. Ganglion impar blocks are a separate specialist procedure and are arranged by referral.

V-ACTOR vibration therapy (vibration therapy) Low-frequency vibration applied over tender muscle. Not a shockwave, despite sharing the machine. Plausible — no studies

What it involves

A vibration handpiece is moved over the tender muscle and fascia for a few minutes. It runs from the same STORZ MASTERPULS icon console as radial shockwave but is a separate handpiece delivering a different, gentler form of energy. No needles, no anaesthetic, no downtime.

What the evidence shows

A combined search for vibration and electromagnetic therapies with coccydynia terms returned no records at all.

Pairing reviewed 2026-09-28.

Where it fits for you

A comfort adjunct at most for gluteal muscle guarding. Not a treatment for the coccyx.

Energy-based treatment options

Radial pressure wave, focused shockwave and EMTT have different targets and different evidence. They are assessed separately rather than treated as one category.

Radial or focused shockwave? Read the overview

Radial shockwave (radial pressure wave) Broad treatment across tender muscle and fascia, close to the surface. Small positive trials

What it involves

A handpiece is moved over the tender tissue while ballistic pressure pulses are delivered, using a transmitter head chosen for the tissue — including heads shaped for fascia and for the muscle either side of the spine. The pulse is strongest at the skin and weakens with depth, so this is mainly a myofascial treatment, though it can reach deeper in some areas. No anaesthetic, no downtime, usually a course of sessions about a week apart.

What the evidence shows

Three small randomised trials report benefit: shockwave beat short-wave diathermy with interferential therapy in 41 patients (Lin, PLoS One 2015), outlasted a steroid injection over six months in 34 (Ahadi, Am J Phys Med Rehabil 2022), and both radial and focused shockwave beat sham in 60, with radial possibly the more effective (Sah, Turk J Phys Med Rehabil 2023). The trials are small, short and mostly single-centre (Mazzoleni, Ann Joint 2025).

Pairing reviewed 2026-09-28.

Where it fits for you

Reasonable to discuss for pain that persists after cushioning, seating changes and physiotherapy, alongside those measures and with the limits of the evidence explained. Not used where infection, fracture or tumour has not been excluded.

Biologic and joint injection options

Each injection is assessed independently for the named diagnosis. Cost, uncertainty, likely benefit, risks and alternatives are part of the decision.

Platelet-rich plasma (PRP) Your own blood, concentrated and injected under ultrasound guidance. Case reports and one cohort

What it involves

Blood is taken from your arm, spun to concentrate the platelets, and injected into the target under ultrasound guidance in the same appointment.

What the evidence shows

PRP has been reported in single case reports (Sussman, Regen Med 2020; Vukovic, Front Immunol 2023) and in a retrospective comparison of 40 patients, in which PRP at the ganglion impar improved function more than pulsed radiofrequency, with no difference in pain (Pilco Inga, Rev Esp Anestesiol Reanim 2025). There is no placebo-controlled trial.

Pairing reviewed 2026-09-28.

Where it fits for you

Not offered routinely. May be discussed as experimental for refractory pain after standard care, with the absence of controlled evidence part of consent.

Prolotherapy (dextrose) A course of dextrose injections into and around the structure and its attachments. No randomised trial

What it involves

Hypertonic dextrose is injected at the tender ligament and tendon attachments, and into the joint where relevant, usually as a series of treatments a few weeks apart.

What the evidence shows

In a case series of 37 people with chronic coccydynia, 30 had good relief after hypertonic dextrose injections (Khan, J Orthop Surg 2008), and a retrospective comparison of 56 found greater pain reduction at three months when ultrasound-guided 10 per cent dextrose was added to exercise (Zure, Pain Manag 2026). Neither is randomised.

Pairing reviewed 2026-09-28.

Where it fits for you

May be discussed for persistent sacrococcygeal ligament pain after standard care, framed as early evidence without a randomised trial.

Nerve-targeted options

Relevant when examination identifies a superficial neuropathic pattern or a compressed peripheral nerve—not simply because pain is present.

Lyftogt perineural therapy (perineural injection therapy) A series of small dilute dextrose injections just under the skin, over tender superficial nerves. One small trial

What it involves

Small injections of low-concentration dextrose, usually 5%, placed just beneath the skin along tender superficial nerves. Given as a series of short sessions.

What the evidence shows

One double-blind randomised trial in 32 women injected 5 per cent dextrose around a small perforating cutaneous nerve at the sacrotuberous ligament, weekly for three sessions: pain fell from about 82 to 37 out of 100 at three months, while the saline group did not change (Alptekin, Ir J Med Sci 2026). It is a single small trial from one group, whose authors include members of a prolotherapy school.

Pairing reviewed 2026-09-28.

Where it fits for you

Considered where examination points to a superficial nerve pain pattern beside the coccyx, as an emerging option and not as established treatment.

Ultrasound-guided nerve hydrodissection Fluid placed around a nerve to free it from the surrounding tissue. Plausible — no studies

What it involves

Under ultrasound, fluid is placed in the plane around the nerve to separate it from the tissue that is tethering or compressing it.

What the evidence shows

A combined search for hydrodissection with coccydynia terms returned no records.

Pairing reviewed 2026-09-28.

Where it fits for you

Not part of managing this condition. The perineural dextrose row covers the nerve-directed injection that has been studied here.

This is general information only and suitability is assessed individually. Treatments with limited or condition-dependent evidence may still be discussed, but only with clear explanation of the uncertainty, the expected benefit, risks, cost and alternatives. Red flags, progressive neurological symptoms or suspected serious pathology require a different pathway.

Every treatment above is described in full on the non-surgical treatments page, including what each one is used for and what the evidence supports. Ratings apply to the named diagnosis; an adjacent muscle, tendon, joint or nerve problem is assessed as a separate target. The method behind the ratings, and the treatments we do not offer, are set out on the evidence page.

A note on cortisone

Corticosteroid injection is reviewed separately for each diagnosis.

Cortisone reliably reduces pain in the short term, and that can be genuinely useful when pain is stopping you sleeping or moving enough to rehabilitate. Beyond that window the picture changes. A systematic review of 41 randomised trials and 2,672 participants found that corticosteroid injection reduced pain in the short term but that the effect reversed at intermediate and long term; in pooled analysis for lateral epicondylalgia the short-term effect was large (SMD 1.44, 95% CI 1.17 to 1.71) while no intervention was favoured at 26 weeks (-0.40, -0.67 to -0.14) and at 52 weeks (-0.31, -0.61 to -0.01) (Coombes, Lancet 2010). In a randomised trial in lateral epicondylalgia, 83 per cent of the corticosteroid group had completely recovered or much improved at one year against 96 per cent given a placebo injection, and recurrence ran at 54 per cent against 12 per cent; adding physiotherapy made no significant difference at one year (Coombes, JAMA 2013). In joints, repeated corticosteroid injections have been associated with cartilage loss. It does not repair anything.

So we do not build treatment plans around it. Where an injection is the right call, we review the specific diagnosis and target, discuss what is being injected and why, keep the number low, and pair it with the loading work that changes the longer-term course.

When we would still consider it

Pain severe enough to block rehabilitation
A clear inflammatory or bursal target on imaging
A specific short-term goal — a trip, a procedure, a return to work
Diagnostic use, where the response tells us where the pain is coming from

When a cortisone injection is worth doing, and when it is not

Other back conditions

Pain in the same area can come from more than one source, and the label matters less than what the examination and history point to. These are the other guides for this region.

Frequently asked questions

Will it go away on its own?

New tailbone pain often settles over weeks to a few months with a cushion and simple measures. Pain that has already lasted several months is less predictable. In one study that followed adults with chronic tailbone pain for three years, symptoms were still present in more than half, so persistent pain is worth a proper assessment rather than more waiting.

Do I need an x-ray?

Not usually at first. Imaging is used after a significant fall, when pain is not settling, or when there are warning signs such as fever, weight loss or night pain. For persistent pain, x-rays taken sitting and standing can show a tailbone that moves too much or too little when you sit, which a standard x-ray can miss.

Is shockwave therapy an option?

It is one of the better-studied treatments for this condition, with three small randomised trials, one against a sham, reporting better pain outcomes than the comparison. The trials were small and short, so it is discussed for pain that persists after cushioning, seating changes and physiotherapy, with those limits explained.

Ready for a clearer plan for your back or musculoskeletal pain?

Book an assessment with Dr Joshua Hatch.

Your assessment focuses on understanding the likely source of your pain and the most appropriate non-surgical options for your diagnosis, with the aim of reducing pain and improving function.

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